Successful treatment of complex cholangiolithiasis following orthotopic liver transplantation with interventional radiology

Figure 1 Imaging of the intra- and extrahepatic bile ducts. A: Magnetic resonance cholangiopancreatography showing a large number of bile duct stones within the intra- and extrahepatic bile ducts (arrows) with a mild dilation of the intrahepatic bile duct; B: Percutaneous transhepatic cholangiography showing the bile duct cast, which is a result of molding of the bile ducts by the stones (arrows).

Figure 2 Crushing of the extrahepatic bile duct stones. Percutaneous transhepatic cholangiography showing that bile duct stones were crushed from the A: Proximal; B: Distal duct with the inflated balloon catheter.

Figure 3 Percutaneous interventional techniques used on the intrahepatic bile stones. A: The intrahepatic bile stones were crushed with the double balloon catheter technique; B: The large residual stones were cut with the basket extractor (arrow).

Figure 4 Elimination of bile duct stones. Percutaneous transhepatic cholangiography showed no presence of the bile stones and a normal biliary tree four months after the percutaneous interventional procedures.